University of Otago, 32 Mein Street, Wellington, New Zealand.
Victoria University of Wellington, Wellington, New Zealand.
Epidemiol Psychiatr Sci. 2020 Dec 2;29:e190. doi: 10.1017/S2045796020001031.
The use of mechanical restraint is a challenging area for psychiatry. Although mechanical restraint remains accepted as standard practice in some regions, there are ethical, legal and medical reasons to minimise or abolish its use. These concerns have intensified following the Convention on the Rights of Persons with Disabilities. Despite national policies to reduce use, the reporting of mechanical restraint has been poor, hampering a reasonable understanding of the epidemiology of restraint. This paper aims to develop a consistent measure of mechanical restraint and compare the measure within and across countries in the Pacific Rim.
We used the publicly available data from four Pacific Rim countries (Australia, New Zealand, Japan and the United States) to compare and contrast the reported rates of mechanical restraint. Summary measures were computed so as to enable international comparisons. Variation within each jurisdiction was also analysed.
International rates of mechanical restraint in 2017 varied from 0.03 (New Zealand) to 98.9 (Japan) restraint events per million population per day, a variation greater than 3000-fold. Restraint in Australia (0.17 events per million) and the United States (0.37 events per million) fell between these two extremes. Variation as measured by restraint events per 1000 bed-days was less extreme but still substantial. Within all four countries there was also significant variation in restraint across districts. Variation across time did not show a steady reduction in restraint in any country during the period for which data were available (starting from 2003 at the earliest).
Policies to reduce or abolish mechanical restraint do not appear to be effecting change. It is improbable that the variation in restraint within the four examined Pacific Rim countries is accountable for by psychopathology. Greater efforts at reporting, monitoring and carrying out interventions to achieve the stated aim of reducing restraint are urgently needed.
机械约束在精神病学中是一个具有挑战性的领域。尽管机械约束在一些地区仍然被认为是标准做法，但出于伦理、法律和医疗方面的原因，应尽量减少或取消其使用。这些问题在《残疾人权利公约》通过后变得更加紧迫。尽管各国都有减少使用机械约束的政策，但机械约束的报告情况很差，这阻碍了对约束流行病学的合理理解。本文旨在制定一种一致的机械约束衡量标准，并在环太平洋地区的国家内部和国家之间进行比较。
我们使用了来自四个环太平洋国家（澳大利亚、新西兰、日本和美国）的公开可用数据，比较和对比了报告的机械约束率。计算了汇总指标，以便进行国际比较。还分析了每个司法管辖区内的差异。
2017 年，国际机械约束率从新西兰的 0.03（每百万人口每天 0.03 例约束事件）到日本的 98.9（每百万人口每天 98.9 例约束事件）不等，差异超过 3000 倍。澳大利亚（每百万人口 0.17 例）和美国（每百万人口 0.37 例）的约束率介于这两个极端之间。以每 1000 个床位日的约束事件数衡量的差异虽然不那么极端，但仍然很大。在所有四个国家中，不同地区的约束差异也很大。在可获得数据的时间段内（最早从 2003 年开始），任何国家都没有显示出约束率稳步下降的趋势。
减少或取消机械约束的政策似乎没有产生效果。在检查的四个环太平洋国家中，约束率的差异不太可能仅仅由精神病理学来解释。迫切需要加强报告、监测和实施干预措施，以实现减少约束的既定目标。
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